Autobiographies of mental health clients: Psychologists' uses and recommendations.

More than 80% of practicing psychologists recommend self-help books to their psychotherapy clients, but only 33% recommend autobiographies written by mental health patients. In this study, 362 psychologists (38% response) provided clinical information and evaluative ratings on such published autobiographical accounts. The effect of reading autobiographies during treatment was typically considered "somewhat helpful." The titles and evaluative ratings of 40 leading autobiographies are provided as a resource for the practitioner; the most valued were An Unquiet Mind, Nobody Nowhere, Darkness Visible, Out of the Depths, and Girl Interrupted. The clinical advantages of recommending published autobiographies to clients are reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of physical health functioning, mental health, and sociodemographic factors in determining the intensity of mental health care use among primary care medical patients.

The present study examined sociodemographic and attitudinal predisposing factors (gender, age, marital status, health insurance, household income, attitudes about mental health care), and need/illness variables (depression severity, physical and mental health functional status) as predictors of past-year mental health care use intensity (i.e., visit counts) and use/nonuse. The sample included 283 adult primary care patients from the Midwestern United States in a cross-sectional study. Nonlinear regression models demonstrated that past-year treatment use intensity was significantly associated with both married status and poorer physical health functioning, while the use (vs. nonuse) of treatment was associated with depression severity. A sociodemographic and attitudinal multivariate predictor model only explained 5% of the variance in treatment use intensity, but a need/illness model significantly contributed an additional 23% variance. Poorer physical health functioning was significant in predicting treatment use intensity, while depression severity was significant in predicting the use (vs. nonuse) of treatment. Results demonstrate the particular importance of physical health problems in determining the intensity of mental health care use, and depression severity in determining the use/nonuse of treatment, notwithstanding the restricted sociodemographic contour of the sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community mental health practice and the elderly.

Discusses some of the working knowledge necessary for a professional psychologist to provide effective mental health services for elderly community residents. The relevance of branches of psychology such as life-span developmental and health and community psychology, which can augment traditional clinical skills, are presented as critical to a psychologist's understanding and management of psychological disorders in older community residents. Also emphasized are the mobility of the psychologist and the provision of services in familiar settings. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Migrant mental health: A model for indicators of mental health and health care consumption.

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed mental health care redux.

Comments on the series on managed health care (MHC) edited by R. L. Lowman (see record 1991-16482-001) that advocated restrictions in MHC to reduce employer costs. It is argued that restricting outpatient coverage is not mandated by economic necessity, and that it creates ethical and clinical risks and ill will toward funders by patients and therapists. Alternative MHC services are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delivery of mental health services in the changing health care system.

Comments on the anonymous article, "Hidden benefits of managed care" (see record 1995-33982-001), in which the author expresses concern that managed care organizations are making decisions on the basis of economics and not the well-being of the patient. B. Miller and L. Farber empathize with the author's concerns, but contend that, if structured properly, HMOs can become the vehicle for the reengineering of mental health services that will produce the best patient outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The economics of mental health care.

Attempts to assist psychologists involved in policy discussions regarding the economics of mental health care by summarizing important sources of information on the characteristics and trends of psychological service providers and the cost of such services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consumers and choice: Cost containment strategies for health care provision.

Examined consumer responses to 3 cost-containment strategies for providing health care. The data come from a random sample of 365 Los Angeles adults (aged 18–65 yrs) interviewed by telephone. It was found that aggregate sample responses were negative toward 2 strategies (labeled preferred provider and health planning) and positive toward the third (labeled self care). It was also found that demographic characteristics that predict approval of one strategy predict disapproval of other strategies. Findings, coupled with models assessing how and why segments of consumers respond as they do, suggest that no one strategy is likely to appeal to all consumers. Implications for the implementation of health care delivery systems inspired by containment strategies are discussed in the context of recent events in California. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An overview of mental health services for the elderly

Psychiatric distress is substantially prevalent among elderly individuals, particularly in the primary care and institutional settings, where most older persons receive mental health care. Barriers to care from providers include negative attitudes and stigmatization and poor recognition by general health care professionals. When psychiatric disorders are recognized, the intensity and duration of treatment provided is generally below standards for adequacy. Further research can determine the impact of patient, caregiver, and provider factors on treatment provision and on patient adherence to treatment. Assessment of factors influencing the treatment process are needed to ensure that treatments provided in the real world approximate the efficacy established in controlled clinical trials.     

Thinking beyond the limitations of mental health care.

Describes the work of the Agency for Health Care Policy and Research (AHCPR). AHCPR used clinical outcome data, practice guidelines, and technology assessment to improve health care service delivery, and AHCPR-supported research and activities encompass all aspects of the quality and accountability continuum. AHCPR also generates and disseminates information that better educate consumers and helps them make informed choices. Future AHCPR directions are described, and the present and future roles of psychologists and psychological services are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational health and the the provision of nursing care for older adults

Providing nursing care to the senior citizen is a rewarding and exciting area of nursing. Care is provided in a vast array of settings from home health and day care to extended residential care sites. These challenges require health care workers to be adaptive and innovative, attentive to detail, compassionate teachers, and promoters of safety for their patients and for themselves. An understanding of the transmission of microorganisms, knowledge of protective mechanisms, and a focus on safety will help ensure good health for the nurse and the elder client. Maintenance of occupational safety and health are combined efforts for the employee and the employer working together to ensure a safe environment for those who need services and those who provide them.     

Alternatives in mental health care and criteria for quality assurance.

The present mental health delivery system is composed largely of hospital services and outpatient office-based services. Alternatives to traditional mental health services have been slow to develop, although their cost-effectiveness is well demonstrated. A major reason for this is that 3rd-party payers are reluctant to reimburse for these services. The present study reviews the development of nontraditional, or alternate, approaches to mental health care and suggest applicable quality assurance strategies. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical applications of telehealth in mental health care.

This article introduces the concept of telehealth and examines how telehealth expands both provider and patient access to health care. Current clinical applications are presented including equipment, research, and examples of direct clinical care. The article focuses on store-and-forward and video teleconferencing technologies providing information about the equipment and research pertaining to the clinical use of the equipment. The status of behavioral telehealth programs in the United States is reviewed and two case examples are provided. The first example discusses a direct patient care system and the second a remote clinical supervision system. The article concludes with suggestions for determining the value of adding telehealth to existing clinical practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The next wave of change for psychology and mental health in the health care revolution.

Recent national changes in the de facto system of health and mental health care are described. Although the percentage of people without health insurance (always or sometimes) has not decreased, the organization of insured care has changed dramatically. Of the insured population, 75% are under some form of managed care. For 88% of the managed care population, mental health care has not been integrated with health care: the so-called carve-out. The author argues that system integration (carve-ins), for a variety of reasons, will begin soon and will occur very rapidly. A tilt toward carve-ins will have substantial impact on psychologists' training, service delivery, and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building a world-class mental health care system for America.

This article examines our current mental health care system, and what can be done to expand this current system. It focuses on the mental health needs of our children, and makes some suggestions to improve their care. Some things discussed are putting more mental health professionals in schools, affordable and convenient treatment options for parents, and flexible treatment arrangements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of opinions regarding mental health benefits in comprehensive health care.

To assess the range of opinions regarding integration of mental health benefits and psychologists into the nation's health care system, a 116-item questionnaire was sent to a sample of the American Psychological Association's membership. The 624 respondents strongly endorsed coverage for traditionally defined (e.g., neuroses, psychoses) disorders treated by orthodox means (e.g., psychotherapy, medication). Ss tended to favor the federal government as a major source of funding for a national health care program, yet they preferred professional control of fee setting and quality assurance. A 2?×?2 MANOVA (Professional Identification?×?Degree) yielded some significant differences between groups with respect to these issues. However, the overall results are more noteworthy for the levels of agreement between groups. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care strategy for mental health services

In the UK, managed care is beginning to be recognized as a cost effective, quality-driven system which can be used to structure patient care. This article examines the potential use of managed care pathways in mental health services, focusing on clients with schizophrenia. The strengths of managed care include the effective coordination of healthcare resources, the clear accountable audit of mental health practice and the re-engineering of mental health practice to improve patient outcomes. Problems in designing representative care pathways and encouraging healthcare providers to implement care pathways are some of the disadvantages of this system.     

Barriers to the provision of mental health services to individuals with severe physical disability.

Surveyed 86 consumer advocates (67 with physical disabilities), 157 rehabilitation counselors, 94 rehabilitation administrators, 323 mental health administrators and professionals, and 145 severely disabled Ss concerning Ss' perceptions of the nature and extent of mental health services, barriers to mental health service provision for individuals with severe physical disabilities, and personal data. Overall, there was a general consistency among the sample groups in their perceptions of the extent to which each of 10 variables is a barrier to service delivery. The lack of accessible public transportation, especially in nonmetropolitan areas, and the accompanying limitation on costly mental health outreach services were viewed as serious problems. The limited knowledge and skills of many mental health professional regarding severe physical disability was perceived to be a moderate to substantial barrier to service provision. Findings indicate that individuals with severe physical disability are an underserved group. Recommendations regarding policy and program development and training of professionals are offered. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on Zimet's mental health care revolution.

Corrects the misstatement by C. N. Zimet (see record 1989-27152-001) by stating that the American Psychological Association (APA) Council of Representatives, at the initiation of the Committee for the Advancement of Professional Practice, unanimously adopted resolution IIE, "Resolution on Managed Health Care" (August 1988) making this resolution a policy of APA binding on all its members. The resolution, contrary to opposing managed care, outlined suggestions for practitioners dealing with managed care entities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Providing mental health care services to Americans.

Summarizes legislation introduced or cosponsored by the author, a US Senator from Minnesota, to respond to Americans' need for mental health services. This legislation included the Medicare Ambulatory Mental Health Services Access Amendments of 1987; S.123, a bill that would amend Part B of the Medicare program to recognize and reimburse psychologists as independent mental health providers; S.763, the Services for Homeless Mentally Ill Individuals Act of 1987; S.809, the Urgent Relief for the Homeless Act; and S.1663, the Child Abuse Prevention Act of 1987. The author encourages mental health professionals to promote public policies that expand Americans' access to public health services through research, effective communication of this research, and preventive mental health efforts (such as programs aimed at preventing teen suicide). (PsycINFO Database Record (c) 2010 APA, all rights reserved)